Randomised controlled trial of albumin infusion in ill preterm infants

Greenough, Anne; Emery, E. F.; Hird, Michael F.; Gamsu, H R

doi:10.1007/bf02072495

Cited by 64 publications

(25 citation statements)

References 13 publications

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“…there were insufficient or no data to assess other clinically important outcomes). The study by Greenough et al (Greenough 1993) did not to report any of our primary and secondary outcome measures.…”

Section: Discussionmentioning

confidence: 96%

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Albumin infusion for low serum albumin in preterm newborn infants

Jardine

Jenkins-Manning

Davies

2003

The Cochrane Database of Systematic Reviews

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Section: Discussionmentioning

confidence: 96%

“…Greenough et al (Greenough 1993) studied the effect of albumin infusion versus placebo on 40 premature infants (28 -34 weeks gestational age, 20 in each group). Study subjects were newborn infants who were ventilator dependant at less than seven days of age and had a serum albumin level of ≤30 g/L.…”

Section: E S C R I P T I O N O F S T U D I E Smentioning

confidence: 99%

Albumin infusion for low serum albumin in preterm newborn infants

Jardine

Jenkins-Manning

Davies

2003

The Cochrane Database of Systematic Reviews

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“…15 By contrast, the infusion of colloidal fluid during the perinatal period in premature infants of median gestational age 27 weeks has been related to an increased duration of oxygen dependency and abnormal neurodevelopmental outcomes. 16,17 In addition, albumin potentially causes deterioration of the protein leak syndrome of prematurity and lung function by deactivation of the surfactant in alveolar spaces.…”

Section: Discussionmentioning

confidence: 99%

Albumin versus normal saline for dehydrated term infants with metabolic acidosis due to acute diarrhea

et al. 2009

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Objective: To compare the efficacy of albumin to normal saline (NS) for initial hydration therapy for dehydrated term infants with severe metabolic acidosis due to acute diarrhea.Study Design: We randomized 33 infants presenting with moderate-tosevere dehydration and metabolic acidosis (pH <7.25 or base excess (BE) <À15) into two groups, an albumin group (n ¼ 15) and a NS group (n ¼ 18). For initial hydration treatment, the albumin group received 5% albumin (10 ml kg À1 ), whereas the NS group received NS (10 ml kg À1 ).Result: After 3 h of treatment, both groups improved. However, the magnitude of improvement in the pH, BE and HCO 3 À levels were not different in comparisons between these two groups. In addition, there were no differences either in the body weight and weight gain 4 days after treatment or in the length of hospital stay. Conclusion:Albumin was not more effective than NS for initial hydration treatment of dehydrated term infants with metabolic acidosis due to acute diarrhea.

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“…ALB-containing solutions are not part of the recommendations because of increased cost, limited availability, a theoretical risk of infectious disease, and in particular a previous observed association with increase mortality in a large meta-analysis of ALB versus crystalloid use across the indications of hypovolemia, burns, and hypoalbuminemia of primarily adult studies (3). Two neonatal trials of hypotensive preterm infants in the neonatal intensive care unit (8,9) were included along with 28 adult trials. Several of the included adult studies suggested that patients who received ALB had worse pulmonary outcomes (10 -12).…”

Section: Discussionmentioning

confidence: 99%

Randomized Trial of Volume Infusion During Resuscitation of Asphyxiated Neonatal Piglets

et al. 2007

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Despite its use, there is little evidence to support volume infusion (VI) during neonatal cardiopulmonary resuscitation (CPR). This study compares 5% albumin (ALB), normal saline (NS), and no VI (SHAM) on development of pulmonary edema and restoration of mean arterial pressure (MAP) during resuscitation of asphyxiated piglets. Mechanically ventilated swine (n ϭ 37, age: 8 Ϯ 4 d, weight: 2.2 Ϯ 0.7 kg) were progressively asphyxiated until pH Ͻ7.0, PaCO 2 Ͼ100 mm Hg, heart rate (HR) Ͻ100 bpm, and MAP Ͻ20 mm Hg. After 5 min of ventilatory resuscitation, piglets were randomized blindly to ALB, NS, or SHAM infusion. Animals were recovered for 2 h before euthanasia and lung tissue sampled for wet-to-dry weight ratio (W/D) as a marker of pulmonary edema. SHAM MAP was similar to VI during resuscitation. The American Academy of Pediatrics/American Heart Association Neonatal Resuscitation Program (NRP) recommends consideration of volume infusion using crystalloid or Onegative blood for neonates with obvious hypovolemic shock and for those not responding to ventilation, cardiac compressions, and epinephrine (1). 5% Albumin (ALB) was removed from the recommendations in 2000, in part due to concerns that ALB may worsen pulmonary edema and increase mortality (2,3). Although guidelines for ALB use in the delivery room were changed, there are no randomized studies assessing the efficacy of any type of volume infusion during delivery room resuscitation of newborns. A recent retrospective study of near-term and term infants reported lower admission blood pressures and higher base deficits that persisted over the first 2 h of life for infants who received volume infusions compared with those that did not during delivery room cardiopulmonary resuscitation (CPR) (4). Due to the retrospective nature of the study, it was unclear whether volume infusion exacerbated the hypotension or whether its use was simply a marker for a more severe injury due to asphyxia. The infrequent and unexpected need coupled with the difficulty of obtaining informed consent for such studies has impeded the design and completion of rigorous randomized delivery room resuscitation trials. Thus, we designed a blinded, randomized, controlled trial to examine the risks and benefits of volume infusion during resuscitation of asphyxiated, hypotensive neonatal piglets whose cardiopulmonary compromise closely parallels that of infants who receive volume resuscitation in the delivery room.Our primary hypothesis was that ALB administration would increase pulmonary edema (as evidenced by lung tissue wetto-dry weight ratio (W/D)) by 20% compared with normal saline (NS) or no volume infusion (SHAM). Additional hypotheses were that administration of ALB would adversely affect respiratory mechanics such as pulmonary dynamic compliance (Cd) but that volume infusion (NS and ALB) would be beneficial compared with SHAM in restoring MAP during resuscitation. METHODS This investigation was approved by the Institutional Review Board for Animal Research at The University of...

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Randomised controlled trial of albumin infusion in ill preterm infants

Cited by 64 publications

References 13 publications

Albumin infusion for low serum albumin in preterm newborn infants

Albumin infusion for low serum albumin in preterm newborn infants

Albumin versus normal saline for dehydrated term infants with metabolic acidosis due to acute diarrhea

Randomized Trial of Volume Infusion During Resuscitation of Asphyxiated Neonatal Piglets

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